Assessment and Management of Pain/nociception in Patients with Disorders of Consciousness or Locked-in Syndrome: A Narrative Review

Overview

Journal Front Syst Neurosci

Specialty Neurology

Date 2023 Apr 6

PMID 37021037

Authors

Estelle A C Bonin

Nicolas Lejeune

Emilie Szymkowicz

Vincent Bonhomme

Charlotte Martial

Olivia Gosseries

Steven Laureys

Aurore Thibaut

Affiliations

Soon will be listed here.

Abstract

The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.

Citing Articles

Cannabigerol (CBG): A Comprehensive Review of Its Molecular Mechanisms and Therapeutic Potential.

Li S, Li W, Malhi N, Huang J, Li Q, Zhou Z Molecules. 2024; 29(22).

PMID: 39598860 PMC: 11597810. DOI: 10.3390/molecules29225471.

Pain anticipation is a new behavioural sign of minimally conscious state.

Sangare A, Munoz-Musat E, Ben Salah A, Valente M, Marois C, Demeret S Brain Commun. 2024; 6(5):fcae311.

PMID: 39346020 PMC: 11430917. DOI: 10.1093/braincomms/fcae311.

Nociception Coma Scale-Revised with Personalized Painful Stimulus Versus Standard Stimulation in Persons with Disorders of Consciousness: An International Multicenter Study.

Formisano R, Aloisi M, Ferri G, Schiattone S, Estraneo A, Magliacano A J Clin Med. 2024; 13(18).

PMID: 39337015 PMC: 11432094. DOI: 10.3390/jcm13185528.

RNA sequencing of the thalamus and rostral ventral medulla in rats with chronic orofacial pain.

Zhang G, Wang L, Wang J, Zeng J, Yu C J Neural Transm (Vienna). 2024; 131(7):739-753.

PMID: 38630191 DOI: 10.1007/s00702-024-02780-4.

Limitation of life sustaining therapy in disorders of consciousness: ethics and practice.

Lissak I, Young M Brain. 2024; 147(7):2274-2288.

PMID: 38387081 PMC: 11224617. DOI: 10.1093/brain/awae060.

References

Laureys S, Celesia G, Cohadon F, Lavrijsen J, Leon-Carrion J, Sannita W . Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010; 8:68. PMC: 2987895. DOI: 10.1186/1741-7015-8-68. View

Coghill R, Sang C, Maisog J, Iadarola M . Pain intensity processing within the human brain: a bilateral, distributed mechanism. J Neurophysiol. 1999; 82(4):1934-43. DOI: 10.1152/jn.1999.82.4.1934. View

De Keyser R, van den Broeke E, Courtin A, Dufour A, Mouraux A . Event-related brain potentials elicited by high-speed cooling of the skin: A robust and non-painful method to assess the spinothalamic system in humans. Clin Neurophysiol. 2018; 129(5):1011-1019. PMC: 6398569. DOI: 10.1016/j.clinph.2018.02.123. View

Di Perri C, Bahri M, Amico E, Thibaut A, Heine L, Antonopoulos G . Neural correlates of consciousness in patients who have emerged from a minimally conscious state: a cross-sectional multimodal imaging study. Lancet Neurol. 2016; 15(8):830-842. DOI: 10.1016/S1474-4422(16)00111-3. View

Grichnik K, Ferrante F . The difference between acute and chronic pain. Mt Sinai J Med. 1991; 58(3):217-20. View

Lejeune N, Petrossova E, Frahm K, Mouraux A . High-speed heating of the skin using a contact thermode elicits brain responses comparable to CO laser-evoked potentials. Clin Neurophysiol. 2022; 146:1-9. DOI: 10.1016/j.clinph.2022.11.008. View

Calabro R, Naro A, Manuli A, Leo A, De Luca R, Lo Buono V . Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?. Clin Neurophysiol. 2017; 128(3):454-462. DOI: 10.1016/j.clinph.2016.12.011. View

Estraneo A, Magliacano A, Fiorenza S, Formisano R, Grippo A, Angelakis E . Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study. Eur J Neurol. 2021; 29(2):390-399. DOI: 10.1111/ene.15143. View

Robertson R, Crawford L, Meylakh N, Macey P, Macefield V, Keay K . Regional hypothalamic, amygdala, and midbrain periaqueductal gray matter recruitment during acute pain in awake humans: A 7-Tesla functional magnetic resonance imaging study. Neuroimage. 2022; 259:119408. DOI: 10.1016/j.neuroimage.2022.119408. View

10.

Peyron R, Frot M, Schneider F, Garcia-Larrea L, Mertens P, Barral F . Role of operculoinsular cortices in human pain processing: converging evidence from PET, fMRI, dipole modeling, and intracerebral recordings of evoked potentials. Neuroimage. 2002; 17(3):1336-46. DOI: 10.1006/nimg.2002.1315. View

11.

Bradley M, Miccoli L, Escrig M, Lang P . The pupil as a measure of emotional arousal and autonomic activation. Psychophysiology. 2008; 45(4):602-7. PMC: 3612940. DOI: 10.1111/j.1469-8986.2008.00654.x. View

12.

de Tommaso M, Navarro J, Ricci K, Lorenzo M, Lanzillotti C, Colonna F . Pain in prolonged disorders of consciousness: laser evoked potentials findings in patients with vegetative and minimally conscious states. Brain Inj. 2013; 27(7-8):962-72. DOI: 10.3109/02699052.2013.775507. View

13.

Merkel S, Voepel-Lewis T, Shayevitz J, Malviya S . The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997; 23(3):293-7. View

14.

Laborde S, Mosley E, Thayer J . Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017; 8:213. PMC: 5316555. DOI: 10.3389/fpsyg.2017.00213. View

15.

Bonin E, Delsemme Z, Blandin V, Alnagger N, Thibaut A, Faymonville M . French Survey on Pain Perception and Management in Patients with Locked-In Syndrome. Diagnostics (Basel). 2022; 12(3). PMC: 8947195. DOI: 10.3390/diagnostics12030769. View

16.

Gard T, Holzel B, Sack A, Hempel H, Lazar S, Vaitl D . Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cereb Cortex. 2011; 22(11):2692-702. PMC: 3968314. DOI: 10.1093/cercor/bhr352. View

17.

Benarroch E . Pain-autonomic interactions: a selective review. Clin Auton Res. 2002; 11(6):343-9. DOI: 10.1007/BF02292765. View

18.

Ingvar M . Pain and functional imaging. Philos Trans R Soc Lond B Biol Sci. 1999; 354(1387):1347-58. PMC: 1692633. DOI: 10.1098/rstb.1999.0483. View

19.

Paccione C, Bruehl S, Diep L, Rosseland L, Stubhaug A, Jacobsen H . The indirect impact of heart rate variability on cold pressor pain tolerance and intensity through psychological distress in individuals with chronic pain: the Tromsø Study. Pain Rep. 2022; 7(2):e970. PMC: 8849278. DOI: 10.1097/PR9.0000000000000970. View

20.

De Schoenmacker I, Berry C, Blouin J, Rosner J, Hubli M, Jutzeler C . An intensity matched comparison of laser- and contact heat evoked potentials. Sci Rep. 2021; 11(1):6861. PMC: 7994633. DOI: 10.1038/s41598-021-85819-w. View